A Review of Skin Banking Guidelines and Standards Worldwide: Towards the Harmonization of Guidelines for Skin Banking in Therapeutic Applications for the Regions under the Asia Pacific Burn Association (APBA).

Currently, there are no harmonized guidelines which govern skin banking in the Asia Pacific region. Therefore, skin banks are either unregulated or rely on their nation's legislation or international accreditation to uphold their quality standards. A new set of skin banking guidelines was developed through a comprehensive review and collation of best international practices for the Asia Pacific Burn Association (APBA) members, from donor screening and testing, to skin recovery, processing, storage and distribution, and quality assurance. National regulatory requirements reviewed include the European directives, Australia's Therapeutic Goods Administration and Singapore's tissue banking standards. Further technical and quality management recommendations are referenced from the American Association of Tissue Banks (AATB), the United States Food and Drug Administration standards and guidance documents, various relevant European guides, Japanese Society of Tissue Transplantation guidelines and the Asia Pacific Association of Surgical Tissue Banking. Adapted mainly from the AATB standards, the new Asia Pacific Burn Association Guidelines for Skin Banking in Therapeutic Applications offer a comprehensive manual, addressing: governance and contracts; staff responsibilities; quality management; facilities, equipment and supplies management; donor consent and testing; and recommendations of good practices pertaining to skin recovery, processing, storage and distribution. Besides complementing current generic regulations, they provide technical specifications of major aspects unaddressed in most legislations. This inaugural set of new regional skin banking guidelines would be a start for regional members of the APBA to adopt, and will hopefully culminate in a set of standards so that, in the long run, skin allografts from this region can be of similar quality, which can simplify import process and facilitate the exchange of allografts between members.

Infection of burn wound by Aspergillus fumigatus with gross appearance of fungal colonies.

The morbidity of invasive aspergillosis in burn patients is low but the diagnosis is difficult and the mortality rate is high. A severe burned patient at the Vietnam National Institute of Burn was suspected of fungal wound infection (FWI) with fungal growth on the wound. The diagnosis of FWI caused by Aspergillus fumigatus was made by isolation and histological examination. This may be the first reported case of FWI caused by Aspergillus fumigatus in Vietnam.

Investigating tolerance ability for early enteral nutrition in severe burned patients

Aim: to investigate the tolerance for early enteral feeding of severe burn patients during 72h postburns at the National Institute of Burns. Method: 41 adullt burn patient admitted to the National Institute of Burn during 72h postburn with a mean of burn area was 49.87% and 15.47% of full thickness area. Naso-gastric tube was inserted as soon as admission, enteral feeding was begun by nutrition pump with Vivonex and then Ensure. Energy requirement was calculated by using curerel formular. Tolerance was canculated as actual volume compared to theory demand. Volume of gastric residual was measured at 2.6 and 24 hour of enteral nutrition. Result: the tolerance was 95.58% success with rare complication including tension apart from diarrhea rate of 19.51%, no case of aspiration was recorded. The tolerance was more successful and less complication was seen in patients fed during the first 6h postburn (p< 0.05). There was no significant relation between diarrhea rate and burn severity as well as plasma albumin level post burn. Conclusion: early enteral feeding is well tolerated with little complication. This method is safe, easy to set up and should be wildly applied for burn patients.

The importance of initial management: a case series of childhood burns in Vietnam.

The success of treatment of childhood burns is critically dependent on how well the initial management is performed. In this case series of 695 children with burns transferred to the National Burn Institute (NBI) in Hanoi from peripheral hospitals, the initial management of each patient was assessed for the following initial management measures: removal of the cause and immediate cooling with water at the accident site; and pain relief, dry dressing, administration of oxygen, and adequate fluid replacement at the peripheral hospital. Overall, 61 of the 695 children died, but of the 95 patients who received all of these initial management measures, all survived. There were no cases of irreversible shock, acute renal failure, or multiple organ failure in the patients who received adequate initial management. Provision of adequate initial management was also significantly protective against septicaemia. Thus in this group of subjects who survived until admission, effective initial management significantly reduced the risk of death and other complications such as irreversible shock, septicaemia and multiple organ failure.

The importance of immediate cooling--a case series of childhood burns in Vietnam.

Numerous experimental studies have shown several benefits of treating burns by the immediate application of cool water. In this study of 695 children with burns, treated in the National Burn Institute (NBI), Hanoi, Vietnam, patients were assessed on admission according to first aid measures at the time of injury, i.e. the removal of the cause and immediate cooling with cold water. A total of 33% of the children who had had immediate cooling of the burn with water had deep burns, compared with 49% of the children who had not had immediate cooling. The prevalence ratio of deep burns was thus 0.68 (95% confidence interval (CI) 0.55-0.85); that is, there was an estimated reduction of 32% in the need for skin grafting, a reduction which was statistically significant. After adjusting for the effect of cooling the burn, removal of the causal agent reduced the odds of requiring skin grafting, but the reduction was not statistically significant. It is concluded that early cooling will prevent a significant percentage of superficial burns from progressing to deep burns. This will not only reduce the probability that skin grafting and expensive treatment will be required, but will reduce the risk of other consequences of deep burns, which may be fatal. Public health programs to promote immediate cooling of burns with cool water are at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children.